Eastern Democratic Republic Of The Congo Research Articles

Expressions of the political: an exploration of women’s infra-politics in artisanal mines in the eastern Democratic Republic of the Congo

ABSTRACT Through an analysis of women who work in artisanal mining in Eastern Democratic Republic of the Congo, this article demonstrates that women are active agents in natural resource extraction in the region, engaging in daily tactics to maintain work and counter gendered exclusions. This article argues that women’s efforts to benefit from mining capitalism go beyond mere survival to foster expressions of infra-politics, where small everyday acts hold broader political significance. This study analyses women’s ‘politics of the everyday’ in a context of political instability and rural poverty, contributing to a broader understanding of what constitutes ‘the political’.

Association between severe acute malnutrition in childhood and hematological disorders in adulthood: the Lwiro follow-up study in the Eastern Democratic Republic of the Congo

BackgroundDespite growing evidence on the short-term deleterious effects of severe acute malnutrition (SAM) in childhood on hematopoiesis, little is known about the long-term hematological effects of SAM in low-income countries (LICs). Our study explored the association between childhood SAM and hematological disorders in adults 11 to 30 years after post-SAM nutritional rehabilitation.MethodsThis follow up study investigated 97 adults (mean age 32 years) treated for SAM during childhood in eastern Democratic Republic of the Congo (DRC) between 1988 and 2007. Participants were compared to 97 aged- and sex-matched adult controls living in the same community with no history of SAM. Outcomes of interest were hematological characteristics and disorders in adulthood, assessed by various biological markers. Logistic and linear regression models were used to estimate the association between SAM in childhood and risk of hematological abnormalities.ResultsCompared to the unexposed, the exposed had higher mean white blood cells (/μl) [+ 840 (179 to 1501), p = 0.013], neutrophils [+ 504 (83 to 925), p = 0.019] and platelets (*103) [11.9 (8.1 to 17.9), p = 0.038] even after adjustment for food consumption in adulthood. No difference was observed in red blood cells (RBC), hemoglobin and erythrocytes parameters. With regard to the risk of hematological disorders, in contrast to the unexposed, exposed subjects had a risk of leukocytosis approximately three times higher [adjusted OR (95% CI): 2.98 (1.01 to 8.79), p = 0.048]. No difference was observed in terms of anemia, leukopenia, increased platelets and thrombocytopenia between the 2 groups.ConclusionAdults with a history of SAM in childhood have hematological characteristics that would be markers associated with chronic low-grade inflammatory or infectious diseases in an environment with no nutritional transition. Larger cohort studies with bone marrow analyses could provide further understanding of the impact of SAM on the overall hematological profile in adult life.

Violence against health care workers in a crisis context: a mixed cross-sectional study in Eastern Democratic Republic of Congo

BackgroundHealth Care Workers (HCWs) in conflict zones face high levels of violence while also playing a crucial role in assisting the population in distress. For more than two decades, the eastern provinces of the Democratic Republic of the Congo (DRC), have been wracked by conflict. This study aims to describe the state of violence against HCWs and the potential prevention mechanisms in eastern DRC.MethodsIn North and South Kivu, between February 5 and 21, 2021, we conducted a mixed cross-sectional convergent study in health facilities (health centers and hospitals). An anonymized self-administered questionnaire was sent to HCWs about their experience of violence in the 12 months prior to the study. In-depth individual interviews with HCWs, present on the day of the investigation, were also done to explore their experience of violence. A descriptive analysis of the quantitative data and a thematic analysis of the qualitative data was carried out.ResultsOf a total of 590 participants, 276 (45.9%) reported having experienced violence in the 12 months before the study. In North Kivu, aggressors were more frequently the patients (43.7% vs. 26.5%) and armed group members (14.3% vs. 7.9%) than in South Kivu. Most respondents (93.5%) reported verbal aggression (insults, intimidation, death threats). Other forms of physical aggression including with bare hands (11.2%), firearm (1.81%), and stabbing (4.7%). Only nearly one-tenth of the attacks were officially reported, and among those reported a higher proportion of sanctions was observed in South Kivu (8.5%) than in North Kivu (2.4%). The mechanisms proposed to prevent violence against HCWs were community initiatives and actions to strength the health system.ConclusionsIn Eastern DRC, HCWs face multiple and severe forms of aggression from a variety of individuals. The effects of such levels violence on HCWs and the communities they served could be devastating on the already pressured health system. Policy framework that defines the roles and responsibilities for the protection of HCWs and for the development and implementation of preparedness measures such as training on management of violence are possible solutions to this problem.

Prevalence and Factors Related to Post-traumatic Stress Disorder and Depression Symptoms Among Children and Adolescents Survivors and Orphans of Ebola Virus Disease in Democratic Republic of the Congo Eastern Regions During the COVID-19 Pandemic

PurposeAlthough previous studies have shown a high prevalence of mental health problems among adult Ebola virus disease survivors, no studies have yet been conducted on mental health problems among children and adolescents in affected regions. Consequently, the current study aimed to examine the prevalence and factors associated with depression and post-traumatic stress disorder (PTSD) among children and adolescent survivors and orphans by utilizing a cross-sectional survey following the 2018–2020 epidemic in Eastern Democratic Republic of the Congo. MethodsA total of 146 survivors (mean age = 13.62, standard deviation [SD] = 2.50, 49.32% female), 233 orphans (mean age = 13.18, SD = 2.96, 53.32% female), and 34 orphan-survivor participants (mean age = 13.39, SD = 2.87, 44.12% female) were recruited. Participants completed measures assessing depression and PTSD symptoms, traumatic experiences, and stigma related to Ebola and COVID-19. ResultsThe prevalence of depression and PTSD symptoms was 87.32% and 44.42%, respectively. Results showed significant differences in depression and PTSD symptoms between orphan-survivors (100% and 97.06%), survivors (90.21% and 75.86%), and orphans (83.48% and 16.52%; χ2(2) = 9.02; p = .011 and χ2(2) = 168.85; p < .001). Experience of traumatic events, Ebola stigmatization, and COVID-19 stigmatization positively predicted depression and PTSD symptoms. The regression models explained 61%–72% of the variance of depression and PTSD. DiscussionThe results reveal that the Ebola virus disease and its associated grief severely jeopardize the mental health of children and adolescents in affected regions. Despite the relative paucity of resources, intervention programs may be helpful to minimize associated stigma and promote psychological support.

Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000-2018: An eco-epidemiological study.

The dynamics of the spread of cholera epidemics in the Democratic Republic of the Congo (DRC), from east to west and within western DRC, have been extensively studied. However, the drivers of these spread processes remain unclear. We therefore sought to better understand the factors associated with these spread dynamics and their potential underlying mechanisms. In this eco-epidemiological study, we focused on the spread processes of cholera epidemics originating from the shores of Lake Kivu, involving the areas bordering Lake Kivu, the areas surrounding the lake areas, and the areas out of endemic eastern DRC (eastern and western non-endemic provinces). Over the period 2000-2018, we collected data on suspected cholera cases, and a set of several variables including types of conflicts, the number of internally displaced persons (IDPs), population density, transportation network density, and accessibility indicators. Using multivariate ordinal logistic regression models, we identified factors associated with the spread of cholera outside the endemic eastern DRC. We performed multivariate Vector Auto Regressive models to analyze potential underlying mechanisms involving the factors associated with these spread dynamics. Finally, we classified the affected health zones using hierarchical ascendant classification based on principal component analysis (PCA). The increase in the number of suspected cholera cases, the exacerbation of conflict events, and the number of IDPs in eastern endemic areas were associated with an increased risk of cholera spreading outside the endemic eastern provinces. We found that the increase in suspected cholera cases was influenced by the increase in battles at lag of 4 weeks, which were influenced by the violence against civilians with a 1-week lag. The violent conflict events influenced the increase in the number of IDPs 4 to 6 weeks later. Other influences and uni- or bidirectional causal links were observed between violent and non-violent conflicts, and between conflicts and IDPs. Hierarchical clustering on PCA identified three categories of affected health zones: densely populated urban areas with few but large and longer epidemics; moderately and accessible areas with more but small epidemics; less populated and less accessible areas with more and larger epidemics. Our findings argue for monitoring conflict dynamics to predict the risk of geographic expansion of cholera in the DRC. They also suggest areas where interventions should be appropriately focused to build their resilience to the disease.

Seroprevalence and associated risk factors of hepatitis C infection among diabetic patients in South-Kivu, Eastern Democratic Republic of the Congo: A cross-sectional study.

Hepatitis C virus (HCV) infection and diabetes mellitus (DM) are two frequent diseases in the Democratic Republic of the Congo (DRC) and several studies seem to show a link between the two diseases worldwide. However, no study has evaluated this link in our country. The present study aimed at determining the seroprevalence of HCV in diabetic patients as well as associated risk factors. A multicenter cross-sectional study allowed us to sample diabetic patients in two diabetic healthcare centers of Bukavu city in the eastern part of the DRC, from December 2020 to December 2022. A questionnaire was submitted to the diabetic patients to collect sociodemographic data, anamnestic data on risk factors for HCV infection, and clinical data on DM. These factors were analyzed based on anti-HCV serological results. Among the 180 selected patients, 19 (10.6%) were tested positive for anti-HCV antibodies. After multivariate analysis, the identified factors influencing these outcomes were male sex (adjusted odds ratio [aOR]: 3.5, p = 0.027), dental extraction (aOR: 7.6, p = 0.001), and living in a privileged environment (aOR: 0.29, p = 0.03). The factors related to DM such as the type, the disease duration, or the usual type of treatment did not influence the serological results. This study shows that HCV seroprevalence in diabetic patients is very high compared with the general population. This suggests combined screening and management policies in this population.

Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo

Non-traumatic coma (NTC) is a common medical condition often associated with poor outcomes. Identifying underlying causes is crucial for effective management and prognostication, particularly in resource-poor settings. This study aimed to identify the most common causes and prognostic factors of NTC in a tertiary hospital in Bukavu, in the eastern Democratic Republic of the Congo (DRC), using the Glasgow Coma Scale (GCS) as well as other simple and affordable clinical and paraclinical tools. This retrospective observational study included 219 consecutive patients admitted to the intensive care unit of the Provincial General Hospital of Bukavu between January 2016 and December 2018. Sociodemographic, clinical, and laboratory data were also collected. Bivariate and multivariate analyses were performed to identify different causes and factors associated with poor outcomes in these patients. The median age of the patients was 49 (interquartile range [IQR]: 33–61) years, and they were predominantly men (62.8%). The most common causes of NTC were stroke (25.7%), acute metabolic complications of diabetes (21.9%), and primary brain infections (meningoencephalitis, 16.0%; and cerebral malaria, 14.2%). The NTC-related in-hospital mortality rate was 35.2%. A high mortality was significantly and independently associated with a GCS<7 (adjusted odds ratio [OR]: 4.30, 95% confidence interval [CI]: 1.73–10.71), the presence of meningismus at clinical evaluation (adjusted odds ratio [aOR] 3.86, 95%CI: 1.41–10.55), oxygen saturation <90% (aOR 3.99, 95%CI: 1.71–9.28), the consumption of traditional herbal medicines prior to hospital admission (aOR 2.82, 95%CI: 1.16–6.86), and elevated serum creatinine (aOR 1.64, 95%CI: 1.17–2.29). In conclusion, clinical neurological examinations, along with simple and affordable paraclinical investigations, can provide sufficient information to determine the etiology of NTC and evaluate the prognosis of comatose patients, even in resource-poor settings. Physicians may use the GCS as a simple, reliable, and affordable tool to identify patients who require special attention and care.

Smallholder cattle farmers’ perceptions, adoption potential, and utilization of trees and shrubs as livestock feeds in the Eastern Democratic Republic of the Congo

ABSTRACTThe sustainability of the livestock sector is negatively affected by insufficient quality and quantity of feeds. The effects of population growth and climate change further exacerbate the availability of feeds. Therefore, developing feasible low-cost strategies to improve year-round feed availability for enhanced livestock production is necessary. The use of trees and shrubs fodder has been recommended as a potential strategy to address feed scarcity. This study evaluated the perceptions, adoption potential, and utilization of trees and shrubs as livestock feeds in the Eastern Democratic Republic of the Congo (DRC) by employing a survey of 805 randomly sampled cattle farmers. The findings revealed that farmers utilized about 62 trees and shrubs for animal fodder. The farmers employed experience-based perceptions to evaluate the suitability of trees and shrubs for fodder based on animal and tree-related criteria. A probit model analysis results indicated that the utilization of trees and shrubs as livestock feeds were influenced by several household demographic factors, livestock farms, farming system factors, and institutional characteristics. The findings provide relevant insights into informing policy formulation and implementation that promote tree and shrub fodder utilization for improved livestock production under smallholder production systems.

Burial workers’ perceptions of community resistance and support systems during an Ebola outbreak in the Eastern Democratic Republic of the Congo: a qualitative study

BackgroundCommunity Health Workers (CHWs) provide vital services during disease outbreaks. Appropriate burials of those who died from an infectious disease outbreak is a critical CHW function to prevent infection and disease spread. During the 2018 Ebola Virus Disease (EVD) outbreak in Beni Town, North Kivu, Democratic Republic of the Congo, we sought to understand the levels of understanding, trust, and cooperation of the community in response to the outbreak, the barriers burial workers faced in their health work and its impact on local burial workers and other CHWs.Methods12 EVD burial CHWs in Beni Town completed an hour-long qualitative in-depth interview on their experiences. They were recruited from a local counseling center. Interviews were recorded, transcribed and translated into English. A team of 3 researchers identified structural and emergent themes using applied thematic analysis.ResultsWorkers reported major misconceptions in the community surrounding the initiation of the outbreak. Community misconceptions were based on widespread governmental mistrust as well as a belief system that intertwines traditional and scientific understandings of the world. EVD burial workers identified violence directed at them and community misinformation as the two largest barriers to effectively carrying out their work. They named several important support systems including family and friends, personal relaxation techniques, and a local counseling center.ConclusionsAs with other disease outbreaks globally, we found that government mistrust and religious beliefs strongly impacted community perceptions of the EVD outbreak. Previous studies have demonstrated clinic-based medical personnel are often the targets of violence. Our research shows that burial workers were also targeted and exposed to extreme levels of violence in their work. Along with their ability to effectively respond to the outbreak, violence has a negative impact on their own mental wellbeing. Burial workers found group counseling sessions to be an effective tool for managing the stress associated with their work. Further developing and testing of group-based interventions for this group is a priority for future research.

Knowledge of Obstetric Danger Signs among Pregnant Women in the Eastern Democratic Republic of the Congo.

A lack of awareness regarding obstetric danger signs (ODS) is one of the factors that delay a pregnant woman's decision to seek emergency obstetric care. In developing countries, this delay can lead to high morbidity and mortality among pregnant women. In eastern Democratic Republic of Congo (DRC), very few studies have been conducted to assess the level of knowledge of pregnant women about ODS. Therefore, this study aimed to assess the knowledge of pregnant women about ODS in health facilities in eastern DRC. This quantitative cross-sectional, descriptive, and analytical study was conducted in 19 health facilities in the Kasongo health zone in the south Maniema Province of eastern DRC. A total of 624 pregnant women aged 12-49 years were interviewed in this study. Of these, 60.6% were secondary school graduates, >99% were married, 85.5% were cultivators, and 67.9% were Muslims. The knowledge of ODS among pregnant women was low (21.9%). The most cited danger signs during pregnancy, labor/delivery, and postpartum included severe abdominal pain and severe vaginal bleeding. Additionally, pregnant women aged 30-39 years (p = 0.015) and those who had given birth once (p = 0.049), twice (p = 0.003), 3-5 times (p = 0.004), and >5 times (p = 0.009) were more likely to be aware of ODS than others. Our findings indicated that pregnant women have little knowledge of ODS, which makes it difficult for them to take prompt decisions to seek emergency obstetric care. Thus, strategies to increase the knowledge of pregnant women about obstetrical danger signs by healthcare providers during prenatal consultations (antenatal care) must be developed to improve their rapid decision-making skills during pregnancy, labor, and postpartum.

Protection, health seeking, or a laissez-passer: Participants’ decision-making in an EVD vaccine trial in the eastern Democratic Republic of the Congo

During the 10th Ebola virus disease (EVD) epidemic in the eastern Democratic Republic of the Congo (DRC) (2018–2020), two experimental EVD vaccines were deployed in North Kivu. This province has been at the centre of conflict in the region for the last 25 years. Amidst ambivalence towards protracted foreign intervention and controversy about introducing two experimental vaccines, the existing literature has focused on mistrust and ‘resistance’ towards the Ebola response and vaccines. In this article, we examine why people in the eastern DRC did decide to volunteer for a trial of a second EVD vaccine in North Kivu, despite the controversy. Drawing on ethnographic observation, interviews, and focus groups with trial participants conducted between September 2020 and April 2021, we analyse three motivations for participating: protection, health seeking, and expectations surrounding travel requirements. We make three points. First, participation in vaccine trials may be understood locally to have advantages which have not been considered by the trial, because they go beyond medical considerations and are specific to a particular social setting. Second, despite much of the literature focusing on a causal relationship between rumours and ‘vaccine hesitancy’, some rumours may in fact encourage participation. Third, material objects associated with trial participation - such as participant vaccine cards - can hold social and political meaning beyond the confines of the vaccine clinic, and influence decisions surrounding participation. Empirical investigation of how medical interventions become entangled in political economies is essential to understanding the perceived functions of participation, and thus the reasons why people volunteer in clinical trials. Participants' narratives about their decision-making provide an insight into how international bioethical debates interact with, but may also stand apart from, the situated social and economic realities driving decision-making around clinical trials on the ground. This highlights the need for ethical approaches that foreground the political, social, and economic context.

Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey

ObjectiveIn the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed...

Assessment of laboratory capacity in conflict-affected low-resource settings using two World Health Organization laboratory assessment tools.

Laboratory diagnostic services are essential to drive evidence-based treatment decisions, manage outbreaks, and provide population-level data. Many low- and middle-income countries (LMICs) lack sufficient diagnostic capacity, often further exacerbated in conflict-affected areas. This project assessed laboratory services in conflict-affected LMICs to understand gaps and opportunities for improving laboratory capacity. The World Health Organization Laboratory Assessment Tool Facility Questionnaire (WHO Laboratory Tool) and Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) checklist were used to assess five laboratories in Eastern Democratic Republic of the Congo (DRC) and five in Gaza, Palestine. Total scores and percentage outcomes by indicator were calculated. Average WHO Laboratory Tool score across all facilities was 41% (range 32-50%) in DRC and 78% (range 72-84%) in Gaza. Lowest scoring indicators in DRC were Biorisk management (13%, range 8-21%), Documentation (14%, range 6-21%), and in Gaza, were Facilities (59%, range 46-75%) and Documentation (60%, range 44-76%). Highest scoring indicators in DRC were Facilities (70%, range 45-83%) and Data and Information Management (61%, range 38-80%), and in Gaza were Data Information and Management (96%) and Public Health Function (91%, range 88-94%). In DRC, no laboratory achieved a SLIPTA star rating. In Gaza, two laboratories had a 3-star SLIPTA rating, one had a 2-star rating and two had a 1-star rating. Laboratory systems in conflict-affected LMICs have significant gaps. Implementating improvement strategies in such settings may be especially challenging.

Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of the Congo, 2018–2020

Abstract During the 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo, the Institut National de Recherche Biomédicale strategically positioned 13 decentralized field laboratories with dedicated equipment to quickly detect cases as the outbreak evolved. The laboratories were operated by national staff, who quickly handed over competencies and skills to local persons to successfully manage future outbreaks. Laboratories analyzed ≈230,000 Ebola diagnostic samples under stringent biosafety measures, documentation, and database management. Field laboratories diversified their activities (diagnosis, chemistry and hematology, survivor follow-up, and genomic sequencing) and shipped 127,993 samples from the field to a biorepository in Kinshasa under good conditions. Deploying decentralized and well-equipped laboratories run by local personnel in at-risk countries for Ebola virus disease outbreaks is an efficient response; all activities are quickly conducted in the field.

Avian Diversity in Nyangezi Wetlands: The Case of Nyamubanda Swamp in the Territory of Walungu, Sud-Kivu, Eastern Democratic Republic of the Congo

Avian Diversity in Nyangezi Wetlands: The Case of Nyamubanda Swamp in the Territory of Walungu, Sud-Kivu, Eastern Democratic Republic of the Congo

Efficiency of Field Laboratories for Ebola Virus Disease Outbreak during Chronic Insecurity, Eastern Democratic Republic of the Congo, 2018–2020

During the 10th outbreak of Ebola virus disease in the Democratic Republic of the Congo, the Institut National de Recherche Biomédicale strategically positioned 13 decentralized field laboratories with dedicated equipment to quickly detect cases as the outbreak evolved. The laboratories were operated by national staff, who quickly handed over competencies and skills to local persons to successfully manage future outbreaks. Laboratories analyzed ≈230,000 Ebola diagnostic samples under stringent biosafety measures, documentation, and database management. Field laboratories diversified their activities (diagnosis, chemistry and hematology, survivor follow-up, and genomic sequencing) and shipped 127,993 samples from the field to a biorepository in Kinshasa under good conditions. Deploying decentralized and well-equipped laboratories run by local personnel in at-risk countries for Ebola virus disease outbreaks is an efficient response; all activities are quickly conducted in the field.

Sexual and gender-based violence victims’ satisfaction of the support services through the holistic model of care in the Democratic Republic of Congo

BackgroundThe quality-of-care assessment is an important indicator of the efficiency of a healthcare system. In the Democratic Republic of the Congo (DRC), despite the implementation of the holistic care model for the treatment of sexual and gender-based violence (SGBV) victims, little is known about the client’s perception of this model and its outcome. This study aimed to examine the expected and perceived satisfaction of service recipients through the One-Stop-Center model of health care in eastern DRC.MethodologyThis descriptive and analytical cross-sectional study was conducted at Panzi Hospital (PH), in eastern DRC. Data were collected by a mixed-methods approach, 64 Victims of Sexual Violence participated in individual (in-depth) interviews and 150 completed the Survey. The Kruskal–Wallis test was used to compare the mean item scores of sexual violence victims’ satisfaction.ResultsThe findings from our qualitative analysis demonstrated that the victims admitted at PH had various expectations and needs on arrival depending on their social identity and residence locations. For instance, the VSVs coming from remote areas with ongoing armed conflicts mentioned concerns related to their security in the post-treatment period and the risks of re-victimization that this could incur. Conversely, those who came from the urban neighborhood, with relative security raised various concerns related to their legal reparation and ongoing access to other support services. With scores above 4, victims of sexual violence were extremely satisfied with the overall care provided and wished that PH could continue to support them mentally and financially for an effective reintegration into their communities. The Kruskal–Wallis analysis confirmed statistically significant differences (p < 0.1) in satisfaction with legal support based on the victims' residential locations, social support based on their age groups, occupational therapy based on their religious denominations, and accommodation based on their professional activity.ConclusionsResults of this study suggest that victims’ satisfaction with support services is based on either the organizational frameworks of clinical or support services within the hospital and the victims’ social environment.

Gully erosion susceptibility mapping using four machine learning methods in Luzinzi watershed, eastern Democratic Republic of Congo

Soil erosion by gullying causes severe soil degradation, which in turn leads to severe socio-economic and environmental damages in tropical and subtropical regions. To mitigate these negative effects and guarantee sustainable management of natural resources, gullies must be prevented. Gully management strategies start by devising adequate assessment tools and identification of driving factors and control measures. To achieve this, machine learning methods are essential tools to assist in the identification of driving factors to implement site-specific control measures. This study aimed at assessing the effectiveness of four machine learning methods (Random Forest (RF), Maximum of Entropy (MaxEnt), Artificial Neural Network (ANN), and Boosted Regression Tree (BRT)) to identify gully's driving factors, and predict gully erosion susceptibility in the Luzinzi watershed, in Walungu territory, eastern Democratic Republic of the Congo (DRC). In this study, gullies were first identified through multiple field surveys and then digitized using a very high-resolution image (CNI/airbus) from Google Earth. Overall, 270 gullies were identified, of which 70% (189) were randomly selected to train the four machine learning methods using topographical, hydrological, and environmental factors hypothesized to be gully-related conditioning factors. The remaining 30% (81 gullies) were used for testing studied methods using the threshold-independent area under the receiver operating characteristic (AUROC) and the true skill statistic (TSS) as performance measures. The results showed that RF and MaxEnt algorithms outperformed other methods; performance assessment results showed that the RF model with AUROC = 0.82 (82%) and MaxEnt (0.804: 80.4%) had higher prediction accuracies than BRT: 0.69 (69%) and ANN: 0.55 (55%). TSS results indicated that RF and MaxEnt are best methods in predicting gully susceptibility in Luzinzi watershed. On the other hand, the conditioning factors such as Digital Elevation Model (DEM), Normalized Difference Water Index (NDWI), Normalized Difference Vegetation Index (NDVI), slope, distance to roads, distance to rivers, and Stream Power Index (SPI) played key roles in the gully occurrence. Given the significance of these factors in gullies' occurrence, as shown in this study, policy-makers must adopt strategies that consider these factors to lower the risk of gully occurrence and related consequences at the watershed scale in eastern DRC.

Clinical progression and outcomes of patients hospitalized with COVID-19 in humanitarian settings: A prospective cohort study in South Sudan and Eastern Democratic Republic of the Congo.

Little information is available on COVID-19 in Africa and virtually none is from humanitarian and more resource-constrained settings. This study characterizes hospitalized patients in the African humanitarian contexts of Juba, South Sudan and North and South Kivu in Eastern Democratic Republic of the Congo. This observational cohort was conducted between December 2020 and June 2021. Patients presenting for care at five facilities or referred from home-based care by mobile medical teams were eligible for enrollment and followed until death or recovery. Disease progression was characterized for hospitalized patients using survival analysis and mixed effects regression model to estimate survival odds for patient characteristics and treatments received. 144 COVID-19 cases enrolled as hospitalized patients were followed to recovery/death. The observed mortality proportion among hospitalized patients was 16.7% (CI: 11.2-23.3%); mortality was three times higher in South Sudan, where patients presented later after symptom onset and in worse conditions. Age and diabetes history were the only patient characteristics associated with decreased survival; clinical status indicators associated with decreased survival included fever, low oxygen level, elevated respiratory and pulse rates. The only therapy associated with survival was non-invasive oxygen; invasive oxygen therapies and other specialized treatments were rarely received. Improving availability of oxygen monitoring and proven COVID-19 therapies in humanitarian and resource-poor settings is critical for health equity. Customizing training to reflect availability of specific medications, therapies and operational constraints is particularly important given the range of challenges faced by providers in these settings.

High Environmental Radioactivity in Artisanal and Small-Scale Gold Mining in Eastern Democratic Republic of the Congo

The radioactivity associated with artisanal and small-scale gold mining activities (ASM) carried out along the Ulindi River, in the eastern Democratic Republic of the Congo, was evaluated by gamma-ray spectrometry and inductively coupled plasma–mass spectrometry of soil and sediment samples. The results revealed that activity concentrations of 238U (up to 3127 ± 98 Bq kg−1), 226Ra (up to 2710 ± 89 Bq kg−1) and 232Th (up to 2142 ± 162 Bq kg−1) were 71- to 89-fold higher than the worldwide average concentrations reported by UNSCEAR in soils. Primordial radionuclides are, thus, present in high concentrations in deposits of gold in that region and the average ambient effective radiation dose rate was determined at 8.4 mSv y−1 (range 0.5 to 40 mSv y−1). This area may be classified as a natural high background radiation area (HBRA). The radiation risk for artisanal miners and population members manipulating those geological materials were assessed through radiological parameters. such as the radium equivalent activity index (RaEq), outdoor gamma absorbed dose rate (ODRA), annual effective dose equivalent (AEDE), and excess lifetime cancer risk (ELCR). The mean values of these parameters were significantly elevated in comparison to the world average levels and indicated the existence of significant radiation risks for gold miners and members of the local population. A radiation safety policy seems needed to protect workers and the local population in this region.